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Vol 19 (2024): Continuous Publishing
Case report
Published online: 2024-05-08

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Right ventricle injury without tamponade symptoms with massive hematoma in anterior mediastinum as a result of stabbing - case report

Kamil Górecki1, Agnieszka Karabin1, Eliza Kuchta1, Justyna Kaniecka1, Klaudia Kasperczuk1, Kamil Baczewski2
DOI: 10.5603/fc.98425

Abstract

Introduction. Heart injuries can be divided into penetrating and blunt traumas. Penetrating injuries most often result from stabbing or gunshot wounds and typically involve the right ventricle of the heart. Most heart injuries carry serious life-threatening complications, such as cardiac tamponade and cardiogenic shock. Even though the wound may be small, it can have significant consequences. The following report presents a case of a patient with a right ventricle heart injury following a stab wound to the chest.

Case report. A 46-year-old patient, under the influence of alcohol, was admitted to the Emergency Department after being stabbed in the anterior chest wall. An urgent contrast-enhanced computed tomography (CT) of the head and chest was performed, which revealed a massive haematoma in the anterior mediastinum with a small amount of blood in the pericardial sac. The CT of the head showed no intracranial bleeding. Despite the absence of cardiac tamponade symptoms, the patient was scheduled for immediate cardiothoracic surgery. After a sternotomy and the opening of the pericardial sac, a hole in the pericardial sac was noticed. The pericardial sac was then opened, and 150 ml of blood was aspirated. The penetrating wound in the right ventricle of the heart was sutured with 5.0 stitches and backing material. Following the surgery, the patient was transferred to the cardiothoracic intensive care unit for further management. During the stay in the unit, the patient remained haemodynamically stable and had good respiratory function. Consultations with psychiatry and neurology were ordered. After two weeks of hospitalization, the patient was discharged home with appropriate recommendations.

Discussion and Conclusion. The cause of the injury was a stab wound from a knife attack. Mortality from heart injuries is high, especially in the case of stabbing wounds. However, prompt surgical intervention significantly reduces mortality and increases the patient’s chances of survival. In the presented case, the absence of cardiac tamponade was remarkable, likely due to the perforation of the pericardial sac and the blood draining into the anterior mediastinum, as evident in the CT scans. This clinical scenario did not lead to haemodynamic instability in the patient. Despite the lack of typical signs of penetrating heart injuries causing cardiac tamponade, the swift surgical procedure to assess the depth of the penetrating wound and the subsequent repair saved the patient’s life.

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